跨腹股沟韧带支架置入治疗左髂静脉长段闭塞性病变的疗效分析

Patency rates after stenting extending below the inguinal ligament for treatment of long-segment left iliac venous obstruction

目的评估采用跨越腹股沟韧带支架置入治疗左髂静脉长段闭塞病变的疗效。方法2012年1月至2017年1月共有73例长段髂股静脉闭塞患者(包括42例急性下肢深静脉血栓形成溶栓后残余左髂静脉长段闭塞和31例深静脉血栓后综合征)接受了介入手术治疗,所有患者均进行球囊扩张并置入至少两枚支架,支架远端越过腹股沟韧带。结果技术成功率为100%,围手术期未发生严重并发症,所有患者肿痛症状均有显著改善,急性下肢深静脉血栓形成溶栓后残余左骼静脉长段闭塞组平均手术时间短于深静脉血栓后综合征组[(35±12)min比(62±12)min,P<0.05]。平均支架数量两组间差异无统计学意义。中位随访时间28.34(12-50)个月,总体累积一期、辅助一期和二期支架通畅率在6个月时分别为100%、100%和100%,12个月时为87.7%、95.9%和100%,24个月时为75.8%、85.1%和96.3%,两组之间差异无统计学意义(均P>0.05),随访期间未发现支架断裂。结论跨腹股沟韧带支架置入治疗长段髂静脉闭塞性病变是一种安全、有效、可行的方法。

Objective To evaluate the technical aspects and examine patency rates of stent placement across the inguinal ligament for managing long-segment iliac venous obstruction.Methods From Jan 2012 to Jan 2017,a total of 73 patients(42 cases of post-acute deep venous thrombosis(DVT)thrombolysis and 31 of post-thrombotic syndrome(PTS))with long-segment iliac venous obstruction were treated with interventional surgery.All patients underwent balloon dilatation and placement of at least two stents extending below inguinal ligament.Results The technical success rate was 100%.No serious perioperative complications occurred.The mean duration of the procedure in the DVT group was shorter than PTS group(35±12)min vs.(62±12)min,P<0.05.The mean number of stents did not differ between the two groups.Mean follow up periods was 28.34 months.Overall cumulative primary,assisted primary,and secondary stent patency rates were 100%,100%,and 100%at 6 months and 87.7%,95.9%,and 100%at 12 months and 75.8%,85.1%,and 96.3%at 24 months,respectively(all P>0.05).Edema and pain alleviated significantly in the two groups.There was no stents compressed or fractured.Conclusions Stenting across the inguinal ligament for treatment of long-segment iliac venous obstruction is a safe,effective,and feasible method.